54 year old man, heavy smoker with poor lung function, presented with severe claudication in both legs. Peripheral angiography along with coronary angiography revealed 100% juxtra-renal abdominal aortic occlusion and critical stenosis of LAD. CT Angio was done to know the condition of external iliacs and femoral arteries. A plan was chalked out. On 29th May, we performed OPCABG: LIMA-LAD and ascending aorta to right femoral artery bypass plus right to left femoral artery bypass using 7mm PTFE ringed grafts through subcutaneous tunnels.

Post-op : Both dorsalis pedis arteries were felt nicely with good doppler signals as well. The patient extubated the same evening and is doing well.


Dr. Ashwani Suri
suricardiac.com

45 year old man fell into a well, thus sustaining multiple injuries – Fractures of the sternum and both left forearm bones, contusion of cervical spine and left knee joint injury.

Presented in shock and respiratory insufficiency. Resuscitated and quick total body scan was done which showed multiple fractures and massive haemopericardium resulting in cardiac tamponade. He required ventilation and ionotropic support along with colloid and crystalloid administration. A quick decision was taken to shift him to the Cardiac OT. Per-operatively, a tear in LA Appendage was successfully repaired without cardio-pulmonary bypass. The unexpected tear in the LA- Appendage was caught with Duval forceps and repaired successfully using two layers of 5,0 Proline Sutures. During opening of the chest, BP dropped to 50mm (S) and after I applied clamp onto the LAA, he suffered a cardiac arrest (hypovolaemic). Blood was rushed and adrenaline shot was also given to gain time. After control of the tear the patient became haemodynamically stable. He did have deranged RFTs and LFTs post-operatively, which recovered in a week’s time. He was discharged home on 12th post-op day.


- Dr.Ashwani Suri

References:

http://link.springer.com/article/10.1007%2Fs00068-002-1191-2#page-1

http://www.journalofthesaudiheart.com/article/S1016-7315(12)00358-2/fulltext

http://asianannals.ctsnetjournals.org/cgi/content/full/9/2/125